Hyperglycaemia, weight loss, intermittent fasting, phentermine

In My Humble Opinion
1

Welp, my lifestyle has finally caught up with me and I’ve been diagnosed with hyperglycemia/type 2 diabetes. This is along with a raft of other problems associated with obesity, poor diet, and a sedentary lifestyle.

I haven’t even told my parents yet because of all the “I told you sos” I expect to hear.

I’m trying to approach this with some degree of calm and determination. Otherwise, combined with all the other disappointments in life, it could send me into a death spiral.

But hey a lot of people have it much worse, even among our friends on this board.

Anyway, I wanted to run by some questions for anyone who might have experience with dealing with high blood sugar. Obviously, the first step is exercise and diet.

I’ve been given several recommendations.

A couple of friends of mine who have high blood sugar are going on and on about Atkins (high protein, high fat, low carbohydrate diet). They love it and are strong proponents.

My doctor is recommending intermittent fasting on a 16-hour fasting schedule. He has used it himself to lose something close to 100 pounds and he’s given me a bunch of literature to back it up. He says that Atkins is too difficult to stick to.

My mental health professional recommends South Beach.

My wife is very opposed to Atkins or intermittent fasting. She thinks that it would cause worse problems in terms of heart issues.

Well, looking at what I have in terms of information, I really need something that is easy for me to stick to, and in those terms I think I can do intermittent fasting. I have sometimes done it accidentally, having eaten nothing from late evening until the next afternoon. I think I could fast from 10 at night to 2 the next afternoon. In fact, I’m doing it right now. I have only had some Coke Zero and some water since last night and I feel fine.

My doctor is also a big proponent of phentermine as an appetite suppressant. He’s prescribed it for me before, but I haven’t used it until a couple of weeks ago. I tried it one day and yeah I definitely wasn’t hungry all day, but I did feel weird and shitty the whole day. And I understand that there are some concerns that it can be addictive.

I don’t know. Does anyone have any experience that might be relevant?

2

Wow, your doctor is suggesting non-traditional dieting measures and appetite suppressants as a means to control diabetes? I’m not an expert but that sounds just awful to me.

I’ve done Atkins twice and lost 80 lbs each time. Put on about 90-100 each time afterwards. It’s a wonderful guide and a great way to learn about carbs and your body but IMHO it’s unsustainable. Don’t be afraid to read the Atkins book, though. Lots of great info!

I’ve tried South Beach but it was super hard. You get most of your calories from veggies and lean meats. This means you are cooking all. the. time. And eating so many veggies…ugh, just, so many veggies. You do cook a lot on Atkins too but you can grab a few slices of beef bologna for a snack or something and you’re satiated - as opposed to however many equivalent calories in lettuce.

I’ve had insulin resistance my whole life, which is why Atkins worked so well for me. I was put on Metformin (the de-facto type 2 diabetes drug) before I was diagnosed with type 2.

When I was diagnosed my doctor upped my Metformin, added another pill that more aggressively drops bloodsugar, had me speak with the diabetes counselor, urged me to be more active (I already was active, I had to step it up) and started having my A1C tested every 3 months as well as visiting him every 3 months.

If I were you I would seek out another doctor, or ask for a referral to an endocrinologist. You need a lifetime plan for bloodsugar and weight management (including diet tips), some medication to help your endocrine system work better, and someone who is going to focus more on just you dropping weigh fast.

3

I’ll offer a few words of second-hand advice, for what utterly little it may be worth…

A friend of mine, age 63 at the time (a year ago) was diagnosed with diabetes. Apparently at a very mild stage at the time (and still, AFAIK).

He now must take meds regularly and watch his diet carefully. Other than that, from what I can tell, his condition seems to have only the most minimal effects on his habitual life-style (which has mostly been very active and still is).

Hope you can derive whatever encouragement you can from that.

4

Intermittent fasting is just about the best thing you can do for yourself. It’s second only to switching to a plant based diet, when you do eat.

16 hours is a good place to start but that leaves you with an 8 hour window of eating. Too long if you’re trying to cut down on caloric intake and maximize weight loss. You should work your way up to eating once a day. So something more in line with 20-22 hour fast, give or take.

High fat diets are not a good idea. I know it was a thing for a while but it’s bullshit, so is Atkins.

Current science says that things like diabetes2 and heart disease can be reversed when you switch to a plant based diet. Ideally that’s plants, legumes, seeds, fruit & whole grains 100% of the time. That’s hard change to make if you’ve been an omnivore all your life. You don’t have to make the change overnight if quitting cold turkey is not your thing. But you should seriously consider a gradual change to your eating habits.

I’ve been doing the 20 hour fasting diet for years and back when I started it helped me lose 90 lbs. Weight I’ve kept off for 15 years now. I’m pretty fit and athletic and I’ve never felt short on energy due to eating only once a day. There was an adjustment period but I don’t recall it ever being very difficult. A great healthy and balanced meal at the end of the day was always my motivation and reward.

I’ve always been an omnivore with a heavy predisposition towards meat consumption. However, I’ve recently decided to start switching to a plant based diet. I won’t lie, it’s a struggle. I’ve yet to make it more than 3 days without meat or cheese. But everything I’ve read convinces me that a plant based diet combined with intermittent fasting is the healthiest thing you can do for yourself.

5

Is a plant based diet the best for your health? I thought Mediterranean was the best for that.

6

I’ve told my own story on these boards before, but there is no harm repeating it. At just over 6’ tall, I weighed 281 around 2000, when my blood sugar was trending up (getting near 7 the way they measure it here–multiply by 18 to get the US numbers) and my doctor recommended the zone diet. There is nothing special about it really. Well balanced, it is basically portion control. So I started doing it. Lost 30 lb and then gained 10 so I was 260 be 2005, when my blood sugar hit 8.1. Started on metformin, one of whose side effects is weight loss. Without any attempt at dieting I lost 20 lb, so down to 240. Where I stayed for several years. Still using the portion control for meals, but eating a lot between meals. Finally, I decided that while you can’t quit eating cold turkey, you could stop noshing. And so I did. I lost 20 lb the first year and 20 the second. My doctor freaked and sent me for X-rays which were negative. Since then, I have hovered mostly between 195 and 200 (with occasional forays above 200 when I am traveling and eating out a lot leaving me with extra salt and holding water) for the last five years. I was 197.6 this morning, for example. BTW, at this point, with BMI around 27, my doctor does not want me to lose any more weight. My blood sugar remains just below 6 with A1C just below 6%.

So I seem to be one of the 10% or whatever who can lose that weight and keep it off. The metformin certainly helps. No one seems to understand why it causes weight loss. I do not, BTW, ever measure my blood glucose level. My doctor feels that is completely unnecessary.

7

I think you’re approaching the problem from the wrong end. As you’ve already learned, everyone has their own idea of the best method for losing weight and staying healthy. Rather than picking someone else’s suggestion, which might not be right for you, you need to start with your own lifestyle and why it’s problematic. What are the points where your own way of eating and other behavior differ from what would generally be considered healthy? If you could make one small change today to be healthier, what would it be? If you try to change in a way that doesn’t fit with your own needs, you won’t succeed. I’m a strong advocate of taking it slowly and experimenting with what works for you on a permanent, rather than temporary basis.

Approaching my own health this way, I’m about to celebrate ten years of success. But I never tell people to follow the specific plan that I follow, because it’s completely based on what works for me. Don’t let anecdotes from other people determine your own approach.

Of course, these recommendations are for the diet and lifestyle piece only. When it comes to hperglycaemia and diabetes, you need to follow any prescribed treatment.

8

That’s exactly what I am doing. I’m collecting ideas and am going to choose based on the information I get from people and from professionals.

As I said, intermittent fasting is something that I’m reasonably confident I can sustain.

I don’t think I’ll be able to sustain something that requires a lot of planning or work or judgment, like South Beach.

When it comes to eating, I am not good at moderation, so a plan that requires me to make multiple decisions about portion control every day is not likely to work with me.

I am under a lot of stress in my professional and personal lives, and food is something that is an unequivocal pleasure for me, so having to control portions 3-6 times a day or having to plan and prepare for every meal to have the right balance of proteins and vegetables is likely a recipe for failure, because I’m likely to just break down and indulge just so I can feel some pleasure for a brief time. And although I like to cook, my days are too long and exhausting for me to do a lot of regular shopping and cooking.

That’s also why a purely plant-based diet is probably not going to work for me. I love animal flesh of all kinds and cheese. I can’t imagine living life without them.

So I’m trying to weigh all these things while taking in information from others around me too.

9

It sounds like you have the right idea, and a good sense of what will work for you.

If you’re likely to break down in order to feel pleasure from food, you might want to think about some alternative forms of pleasure to indulge in when you get to that point.

I’m totally with you on the cheese, though. I think I lasted 3 days without cheese.

10

I’d like to see your cites for both of these claims. Eating multiple small meals in better for controlling blood sugar than one big one & fasting.

11

The scientific articles that the claims are based on are linked in the citations.

12

Did you even look at your cites?
First of all, the OP is talking about intermittent fasting in terms of fasing for 16 hours daily and then having an 8 hour “window” when he can eat, while that article is talking about a regimen where you severely restrict intake for several days each week alternating with days where you eat what you want, which is an entirely different regimen.
Second, the studies are mostly on animals, and there are no good outcome studies. For example, the study that shows your basal metabolic rate increases is actually a study of what happens to lean people after fasting for 48 hours and how they respond to an infusion of epinephrine. It certainly does not indicate any sustained increase in metabolism in the situation the OP describes.

That said, the most important thing is having something you can stick to. I think the OPs doctor is projecting his own feelings on the OP. Since he found Atkins hard to stick to, it therefore means that everyone else will. Studies actually show that what works for any individual is a plan that that particular individual can stick to. For some people who cannot live without bacon and cheese, Atkins may be the best option. For those who cannot live without fruit and grains, a vegetarian diet may be preferable. Studies have shown that in the long term, both carbohydrate restriction and fat restriction produce fairly equivalent weight loss.

I do think that monitoring blood sugars may be useful. For somebody who sees a large sugar jump after a high carbohydrate meal, intermittent fasting with one large meal daily may not be as helpful as spreading out the meals. I also am wary of a physician who pushes weight loss medications. Granted, there are some weight loss medications that are approved for long-term use, but phentermine is not one of them and does not have any good long-term data.

13

My husband is a diabetes 2 suspect. He wasn’t told to follow any specific diet except to explore what’s out there, and, following his doctor’s general parameters, see what’s comfortable for him and our lifestyle. So far lowering carbs, upping protein/veggie intake, and having fruit rather than ice cream for dessert is working for him. He has a worse sweet tooth than mine, but it’s interesting that the less sugar he eats overall, the less he wants it.

I have no need to follow this kind of diet but I do so because it’s easier. I’ve lost some weight on it. We allow for a once a week cheat like pizza. Right now I have the luxury of cooking most of our meals but once I return to work it’ll be a different story.

14

this right here

15

There is quite a bit of fact based scientific research out there on intermittent fasting.

This is a very good summary but you’ll have to do a little google work to confirm the claims it makes.

Here is one cited article from NIH.

Another from Johns Hopkins Health Review.

Autophagy benefits due to IFis a prominent factor in helping people overcome various disease processes.

Current clinical trials on human subjects to validate various health benefit claims.

There is an abundance of research on the benefits of IF. I do not believe there is any doubt in the science community about the fact that IF is beneficial. I encourage anyone interested in the subject to do your own research.

16

Anecdotally, I’ve found that following the 5-2 style of intermittent fasting has worked well for my fasting sugars. Before I started this I found that my morning sugars were between 6.5 and 7.2 fairly consistently. I could not get that morning reading lower regardless of my eating habits the previous night. Once I started doing the fasting my morning sugars lowered to between 5.7 and 6.5 pretty consistently. I’ve only been doing the fasting for 5 to 7 weeks so I don’t know if the results will continue over time.

I find the 5-2 style easy to follow. I eat normally (and fairly heathily) for 5 days. On non-consecutive days twice a week I have a small to medium apple for lunch and skip any snacks after supper. This keeps me between 600 to 800 calories for that day and seems to have an affect. The one or two weeks that I’ve not done the fasting I notice my sugars creeping up in the mornings again.

17

I loved phentermine. Loved, loved, loved. I wasn’t hungry. I was energized. I wasn’t grouchy from being hungry.

But it’s not a long-term solution; the weight crept back on. I took it in the mid-1990s, and never again. Pills generally aren’t a good answer to weight loss.

18

Want to add that glucose spikes after eating are often a matter of what you eat, not how often you eat. Also, variation in blood sugar is not the boogeyman it’s been made out to be. Most people can cope. Including those with type 2 diabetes.

Here is an article that addresses evidence that fat, not sugar, in diet is responsible for high blood sugar and why high animal fat diets like Atkins will eventually make people more likely to get type 2 diabetes.

The above link has additional linked articles and related scientific studies. I know it’s not very convenient to have to click through more links to get a more complete picture but Dr. Greger MD, seems legit - though a bit dorky and kooky.

19

I came to IF on my own about 15 years ago not because of anything I researched but for the reasons you expressed above. I simply found that managing my caloric intake while not feeling like I was depriving myself did the trick for me. Skipping breakfast and lunch is easy when you know you can eat (almost) whatever you want at dinner.

It was sheer dumb luck that what I stumbled on is an IF lifestyle diet.

This is my current struggle as well. I’ve been a carnivore through and through my entire life. While IF in combination with a lot of hours in the gym allowed me to lose and maintain a very healthy weight for many years, the health benefits of a plant based diet are becoming too obvious to ignore. I feel like I need to try. I may never achieve 100% plant based nutrition. For now, my goal is to break the daily animal based diet habit.

I think you’re on the right track with the right mindset. It doesn’t have to be an all or nothing thing. Baby steps.

20

I’m trying to lose weight. So far, the only eating restriction that seems to work for me is eating a big breakfast or midday meal, and then maybe having a snack (around 200 calories, like a protein bar, or something) in the afternoon. I don’t eat after that, mainly because I’m not hungry.

If I eat well in the morning (something proteinaceous, with vegetables and some sort of non-refined complex carb), I don’t get very hungry during the day. I’m also in a better mood, have more energy, and find it easier to focus. If I skip breakfast, or don’t eat until I’m really satisfied, I end up eating much more later on to make up for it.

I don’t know if not eating from the afternoon through about 7 am the next morning counts as intermittent fasting, but I think it’s something I can stick to that will lower my total number of calories taken in each 24 hours. I’m new at this, but so far, so good.

Oh, and one other change–I’m going to bed when I’m tired. That seems to help mood, focus, and energy, too. When I force myself stay up to try to get work done, I end up eating a bunch of crap. (That’s not a deliberate choice, as far as I can tell. It’s more like, I get hungry, and then I eat something sugary, which gives me a jolt of energy and lets me burn the midnight oil.) Maybe just getting to sleep when I want to is helping me cut down on calories.